Lippincott's QA review book ?s: Eyes and Ears

5. A client tells the nurse his vision is blurred and hazy throughout the entire day. The nurse should recommend that the client do which of the following? 1. Purchase a pair of magnifying glasses. 2. Wear glasses with tinted lenses. 3. Schedule an appointment with an optician. 4. Schedule an appointment with an ophthalmologist.

4. An ophthalmologist is a physician who specializes in the treatment of disorders of the eye, and the nurse should advise the client to see a physician. An optician makes glasses and it is not known at this point what the best treatment for the client is. Magnifying glasses, or glasses with tinted lenses, do not correct hazy or blurred vision. If glasses are needed to correct refractive errors, they should be prescription glasses.

32. A 27-year-old female is admitted for elective nasal surgery for a deviated septum. Which of the following would be an important initial clue that bleeding was occurring even if the nasal drip pad remained dry and intact? 1. Complaints of nausea. 2. Repeated swallowing. 3. Rapid respiratory rate. 4. Feelings of anxiety.

2. Because of the dense packing, it is rela- tively unusual for bleeding to be apparent through the nasal drip pad. Instead, the blood runs down the throat, causing the client to swallow frequently. The back of the throat can be assessed with a flashlight. An accumulation of blood in the stomach may cause nausea and vomiting, but is not an initial sign of bleeding. Increased respiratory rate occurs in shock and is not an early sign of bleeding in the client after nasal surgery. Feelings of anxiety are not indicative of nasal bleeding.

50. A client with Ménière's disease continues to have disabling attacks of vertigo and elects to have a labyrinthectomy. A priority nursing diagnosis for the client before surgery is: 1. Deficient diversional activity related to inability to participate secondary to vertigo. 2. Risk for injury related to vertigo. 3. Powerlessness related to inability to influence effects of disease process 4. Social isolation related to hearing loss.

2. The client's Risk for injury related to vertigo is the highest priority nursing diagnosis preoperatively. The client should be instructedhow to manage attacks of vertigo safely. Deficient diversional activity related to inability to participate secondary to vertigo is an appropriate nursing diagnosis, but it is not a priority. Powerlessness related to inability to influence effects of the disease process is a possible diagnosis, but more data are required before making such a diagnosis. Social isolation related to hearing loss is a possible diagnosis for the client after surgery. The client retains the ability to hear with Ménière's disease; however, total hearing loss is a possible complication of labyrinthectomy.

39. Sensorineural hearing loss results from which of the following conditions? 1. Presence of fluid and cerumen in the external canal. 2. Sclerosis of the bones of the middle ear. 3. Damage to the cochlear or vestibulocochlear nerve. 4. Emotional disturbance resulting in a func- tional hearing loss.

3. A sensorineural hearing loss results from damage to the cochlear or vestibulocochlear nerve. Presence of fluid and cerumen in the external canal or sclerosis of the bones of the middle ear results in a conductive hearing loss. Hearing loss resulting from an emotional disturbance is called a psycho- genic hearing loss.

31. When the nurse enters the client's room, the nurse perceives that the client is staring straight ahead. Which of the following is the best course of action for the nurse to take next? 1. Hold an interdisciplinary meeting on the client's behalf promptly. 2. Consult with psychiatry. 3. Listen to the client and observe the body language. 4. Address the client by first name upon enter- ing the room.

3. By listening to the client should they speak and by noting body language, the nurse may be better able to ascertain the client's physical and cognitive status. The nurse should not utilize the first name of a client unless a client provides permission to do so. To consult with psychiatry would not be appropriate unless ordered by the primary care physician. An interdisciplinary meeting would not enable the nurse to understand why the client is staring straight ahead. Perhaps the client is only deep in thought.

29. Although all of the following measures might be useful in reducing the visual disability of a client with adult macular degeneration (AMD), which measure should the nurse teach the client primarily as a safety precaution? 1. Wear a patch over one eye. 2. Place personal items on the sighted side. 3. Lie in bed with the unaffected side toward the door. 4. Turn the head from side to side when walking

4. To expand the visual field, the partially sighted client should be taught to turn the head from side to side when walking. Neglecting to do so may result in accidents. This technique helps maximize the use of remaining sight. A patch does not address the problem of hemianopsia. Appropriate client positioning and placement of personal items will increase the client's ability to cope with the problem but will not affect safety.

20. The nurse should assess clients with chronic open-angle glaucoma (COAG) for: 1. Eyepain. 2. Excessive lacrimation. 3. Colored light flashes. 4. Decreasing peripheral vision.

4. Although COAG is usually asymptomatic in the early stages, peripheral vision gradually decreases as the disorder progresses. Eye pain is not a feature of COAG but is common in clients with angle-closure glaucoma. Excessive lacrimation is not a symptom of COAG; it may indicate a blocked tear duct. Flashes of light is a common symptom of retinal detachment.

23. A client uses timolol maleate (Timoptic) eyedrops. The expected outcome of this beta-adrenergic blocker is to control glaucoma by: 1. Constricting the pupils. 2. Dilating the canals of Schlemm. 3. Reducing aqueous humor formation. 4. Improving the ability of the ciliary muscle to contract.

3. Timolol maleate (Timoptic) is commonly administered to control glaucoma. The drug's action is not completely understood, but it is believed to reduce aqueous humor formation, thereby reducing intraocular pressure. Timolol does not constrict the pupils; miotics are used for pupillary constriction and contraction of the ciliary muscle. Timolol does not dilate the canal of Schlemm.

45. A client has vertigo. Which of the following actions would be most appropriate for the nursing diagnosis of Risk for injury related to altered immobility and gait disturbances? Select all that apply. 1. The client assumes safe position when dizzy. 2. The client experiences no falls. 3. The client performs vestibular/balance exercises. 4. The client demonstrates family involvement. 5. The client keeps head still when dizzy.

1, 2, 3, 5. Assessment of vertigo, including history, onset, description of attacks, duration, frequency, and associated ear symptoms, is important. Vestibular/balance therapy or exercises should be taught and practiced. The client needs to be instructed to sit down when dizzy and decrease the amount of head movement. The client will benefit from recognizing whether he or she experiences an "aura" before an attack so appropriate action can be taken. Finally, it is recommended that the client keep the eyes open and look straight ahead when lying down. These expected outcomes will prevent the problem of injury. Family involvement is essential when dealing with a client experiencing vertigo but is not applicable for this particular nursing diagnosis.

8. Which of the following is a potential complication following cataract surgery? Select all that apply. 1. Acute bacterial endophthalmitis. 2. Retrobulbar hemorrhage. 3. Rupture of the posterior capsule. 4. Suprachoroidal hemorrhage. 5. Vision loss.

1, 5. Acute bacterial endophthalmitis can occur in about 1 out of 1,000 cases. Organisms that are typically involved include Staphylococcus epidermidis, S. aureus, and Pseudomonas and Proteus species. Vision loss is one result of acute bacterial infection. In addition, vision loss can be the result of malposition of the intraocular lens implant or opacification of the posterior capsule. Retrobulbar hemorrhage is a complication that may occur right before surgery and is a result of retrobulbar infiltration of anesthetic agents. Rupture of the posterior capsule and suprachoroidal hemorrhage are both complications that can result during surgery.

42. To prepare the irrigation solution used for removal of cerumen, the nurse should use: 1. Normal saline. 2. Sterile water. 3. Antiseptic solution. 4. Warm tap water.

1. Normal saline is the solution that is generally used to irrigate the ear. Sterile water will cause tissue damage. An antiseptic solution is not typically used unless an infection is present. Warm tap water may cause tissue damage.

33. The client is ready for discharge after sur- gery for a deviated septum. Which of the following discharge instructions would be appropriate? 1. Avoid activities that elicit Valsalva's maneuver. 2. Take aspirin to control nasal discomfort. 3. Avoid brushing the teeth until the nasal pack- ing is removed. 4. Apply heat to the nasal area to control swelling.

1. The client should be instructed to avoid any activities that cause Valsalva's maneuver (e.g., straining at stool, vigorous coughing, exercise) to reduce stress on suture lines and bleeding. The client should not take aspirin because of its anti- platelet properties, which may cause bleeding. Oral hygiene is important to rid the mouth of old dried blood and to enhance the client's appetite. Cool compresses, not heat, should be applied to decrease swelling and control discoloration of the area.

43. A client is about to have a tympanoplasty, and asks the nurse what the surgical procedure involves. The nurse begins the conversation by: 1. Assessing the client's understanding of what the physician has explained. 2. Describing the surgical procedure. 3. Educating the client that the procedure will close the perforation and prevent recurrent infection. 4. Informing the client that the procedure will improve hearing.

1. The nurse should first assess the client's knowledge base. Working within the framework of the client's knowledge and educational level, the nurse then can describe the procedure and its benefits.

16. Which of the following statements would provide the best guide for activity during the rehabilitation period for a client who has been treated for retinal detachment? 1. Activity is resumed gradually, and the client can resume her usual activities in 5 to 6 weeks. 2. Activity level is determined by the client's tolerance; she can be as active as she wishes. 3. Activity level will be restricted for several months, so she should plan on being sedentary. 4. Activity level can return to normal and may include regular aerobic exercises.

1. The scarring of the retinal tear needs time to heal completely. Therefore, resumption of activity should be gradual; the client may resume her usual activities in 5 to 6 weeks. Successful healing should allow the client to return to her previous level of functioning.

12. After cataract removal surgery, the client is instructed to report sharp pain in the operative eye because this could indicate which of the following postoperative complications? 1. Detached retina 2. Prolapse of the iris 3. Extracapsular erosion 4. Intraocular hemorrhage

4. Sudden, sharp pain after eye surgery should suggest to the nurse that the client may be experiencing intraocular hemorrhage. The physician should be notified promptly. Detached retina and prolapse of the iris are usually painless. Extracapsular erosion is not characterized by sharp pain.

1. The nurse is observing a student nurse administer eyedrops, as shown in the figure. What should the nurse instruct the student to do? 1. Move the dropper to the inner canthus. 2. Have the client raise her eyebrows. 3. Administer the drops in the center of the lower lid. 4. Have the client squeeze both eyes after administering the drops.

3. The student has positioned the dropper and the client correctly to prevent injury to the client's eye. The student should administer the drops in the center of the lower lid. Following administration of the eyedrops, the client should blink her eyes to distribute the medication; squeezing or rubbing her eyes might cause the medication to drip out of the eye.

3. The client has had a cataract removed. The nurse's discharge instructions should include which of the following? 1. Keep the head aligned straight. 2. Utilize bright lights in the home. 3. Use an eye shield at night. 4. Change the eye patch as needed.

3. Using an eye shield at night prevents rubbing the eye. The head should be turned to the side to scan the entire visual field to compensate for impaired peripheral vision. Eye medications may initially cause sensitivity to bright light. The surgeon changes the eye patch on the second postoperative day.

13. The client is diagnosed in the emergency department with a detached retina in the right eye. The nurse should do which of the following first? 1. Apply compresses to the eye. 2. Instruct the client to lie prone. 3. Remove all bed pillows. 4. Promote measures that limit mobility.

4. Promoting measures that limit mobility may prevent further injury. Following surgical repair of a detached retina, cool or warm compresses are applied to edematous eyelids, if ordered. The client should avoid lying face down, stooping, or bending pre-operatively. It is not necessary to remove all pillows.

44. An older adult takes two 81 mg aspirin tablets daily to prevent a heart attack. The client reports having a constant "ringing" in both ears. How should the nurse respond to the client's comment? 1. Tell the client that "ringing" in the ears is associated with the aging process. 2. Refer the client to have a Weber test. 3. Schedule the client for audiometric testing. 4. Explain to the client that the "ringing" may be related to the aspirin.

4. Tinnitus (ringing in the ears) is an adverse effect of aspirin. Aspirin contains salicylate, which is an ototoxic drug that can induce reversible hearing loss and tinnitus. The nurse should encourage the client to inform the physician of the symptom. Tinnitus is not a function of aging. The Weber test and audiometric testing are useful for determining hearing loss but are not necessarily helpful in the management or diagnosis of drug-induced tinnitus

15. The client with retinal detachment in the right eye is extremely apprehensive. He states, "I'm afraid of going blind. It would be so hard to live that way." What factor should the nurse consider before responding to his statement? 1. Repeat surgery is impossible, so if this procedure fails, vision loss is inevitable. 2. The surgery will only delay blindness in the right eye, but vision is preserved in the left eye. 3. More and more services are available to help newly blind people adapt to daily living. 4. Optimism is justified because surgical treatment has a 90% to 95% success rate.

4. Untreated retinal detachment results in increasing detachment and eventual blindness, but 90% to 95% of clients can be successfully treated with surgery. If necessary, the surgical procedure can be repeated about 10 to 14 days after the first procedure. Many more services are available for newly blind people, but ideally this client will not need them. Surgery does not delay blindness.

37. The nurse has been assigned to a client who is hearing impaired and reads speech. Which of the following strategies should the nurse incorporate when communicating with the client? Select all that apply. 1. Avoiding being silhouetted against strong light. 2. Not blocking out the person's view of the speaker's mouth. 3. Facing the client when talking. 4. Having bright light behind so the individual can see. 5. Ensuring the client is familiar with the subject material before discussing. 6. Talking to the client while doing other nursing procedures.

1, 2, 3, 5. When working with a client whois hearing impaired and speech reads, the presenter must face the person directly and devote full attention to the communication process. In addition,it will be useful for the client that the speaker not be too silhouetted against strong light, that the speaker's mouth not be blocked from the client's view, and that there are no objects in the mouthof the speaker. Finally, it is recommended that the presenter provide the client with the needed information to study before reviewing. This will provide the client with the ability to use contextual clues in speech reading.

46. The client with Ménière's disease is instructed to modify his diet. The nurse should explain that the most frequently recommended diet modification for Ménière's disease is: 1. Low sodium. 2. High protein. 3. Low carbohydrate. 4. Low fat.

1. A low-sodium diet is frequently an effective mechanism for reducing the frequency and severity of the disease episodes. About three-quarters of clients with Ménière's disease respond to treatment with a low-salt diet. A diuretic may also be ordered. Other dietary changes, such as high protein, low carbohydrate, and low fat, do not have an effect on Ménière's disease.

10. After returning home, a client who has had cataract surgery will need to continue to instill eye drops in the affected eye. The client is instructed to apply slight pressure against the nose at the inner canthus of the eye after instilling the eyedrops. The rationale that supports applying pressure is that it: 1.Prevents the medication from entering the tear duct. 2. Prevents the drug from running down the client's face. 3. Allows the sensitive cornea to adjust to the medication. 4. Facilitates distribution of the medication over the eye surface.

1. Applying pressure against the nose at the inner canthus of the closed eye after administering eyedrops prevents the medication from entering the lacrimal (tear) duct. If the medication enters the tear duct, it can enter the nose and pharynx, where it may be absorbed and cause toxic symptoms. Eyedrops should be placed in the eye's lower conjunctival sac. Applying pressure will not prevent the drug from running down the face as long as the drops are instilled in the eye. Pressure does not affect the cornea or facilitate distribution of the medication over the eye surface.

40. A 65-year-old male has hearing loss and a sensation of fullness in both ears. The nurse examines his ears with the understanding that a common cause of hearing loss in older adults is related to: 1. Accumulation of cerumen in the external canal. 2. Accumulation of cerumen in the internal canal. 3. External otitis. 4. Exostosis.

1. Cerumen (ear wax) commonly gets impacted in older clients in the external canal. Otalgia is the "fullness" sensation or pain that an older client may experience when the cerumen becomes impacted. External otitis is an inflammation of the outer ear and would not explain the symptoms the client is experiencing. Exostosis is a bony growth that arises from the surface of a bone and would not explain the symptoms the client is experiencing.

27. The nurse should assess an older adult with macular degeneration for: 1. Loss of central vision. 2. Loss of peripheral vision. 3. Total blindness. 4. Blurring of vision.

1. Macular degeneration generally involves loss of central vision. Gradual blurring of vision can occur as the disease progresses and may result in blindness; however, loss of central vision is the most common finding. Tiny yellowish spots, known as drusen, develop beneath the retina. Loss of periph- eral vision is characteristic of glaucoma.

14. A client with detachment of the retina is to patch both eyes. The expected outcome of patching is to: 1. Reduce rapid eye movements. 2. Decrease the irritation caused by light entering the damaged eye. 3. Protect the injured eye from infection. 4. Rest the eyes to promote healing.

1. Patching the eyes helps decrease random eye movements that could enlarge and worsen retinal detachment. Although clients with eye injuries frequently are light-sensitive, and preventing infection is important, the specific goal is to reduce rapid eye movements. Resting the eye is an indirect way of stating the objective.

9. The nurse is instructing the client about postoperative care following cataract removal. What position should the nurse teach the client to use? 1. Remain in a semi-Fowler's position. 2. Position the feet higher than the body. 3. Lie on the operative side. 4. Place the head in a dependent position.

1. The nurse should instruct the client to remain in a semi-Fowler's position or on the nonoperative side. Positioning the feet higher than the body does not affect the operative eye; placing the head in a dependent position could increase pressure within the eyes.

11. To decrease intraocular pressure following cataract surgery, the nurse should instruct the client to avoid: 1. Lying supine 2. Coughing 3. Deep breathing 4. Ambulation

2. Coughing is contraindicated after cataract extraction because it increases intraocular pressure. Other activities that are contraindicated because they increase intraocular pressure include: turning to the operative side, sneezing, crying, and strain- ing. Lying supine, ambulating, and deep breathing do not affect intraocular pressure.

17. Which of the following goals is a priority for a client who has undergone surgery for retinal detachment? 1. Control pain 2. Prevent an increase in intraocular pressure 3. Promote a low-sodium diet 4. Maintain a darkened environment.

2. After surgery to correct a detached retina, prevention of increased intraocular pressure is the priority goal. Control of pain with analgesics is the second goal. Following a low sodium diet or maintaining a darkened environment is not a goal for this client.

6. The nurse is to instill drops of phenylephrine hydrochloride (Neo-Synephrine) into the client's eye prior to cataract surgery. Which of the following is the expected outcome? 1.Dilation of the pupil and blood vessels. 2. Dilation of the pupil and constriction of blood vessels. 3. Constriction of the pupil and constriction of blood vessels. 4. Constriction of the pupil and dilation of blood vessels.

2. Instilled in the eye, phenylephrine hydrochloride (Neo-Synephrine) acts as a mydriatic, causing the pupil to dilate. It also constricts small blood vessels in the eye.

57. The client with glaucoma is scheduled for a hip replacement. Which of the following orders would require clarification before the nurse carries it out? 1. Administer morphine sulfate. 2. Administer atropine sulfate. 3. Teach deep-breathing exercises. 4. Teach leg lifts and muscle-setting exercises.

2. Atropine sulfate causes pupil dilation.This action is contraindicated for the client with glaucoma because it increases intraocular pressure. The drug does not have this effect on intraocular pressure in people who do not have glaucoma. Morphine causes pupil constriction. Deep-breathing exercises will not affect glaucoma. The client should resume taking all medications for glaucoma immedi- ately after surgery.

36. A 75-year-old client who has been taking furosemide (Lasix) regularly for 4 months tells the nurse that he is having trouble hearing. What would be the nurse's best response to this statement? 1. Tell the client that because he is 75 years old, it is inevitable that his hearing should begin to deteriorate. 2. Have the client immediately report the hearing loss to his physician. 3. Schedule the client for audiometric testing and a hearing aid. 4. Tell the client that the hearing loss is only temporary; when his system adjusts to the furosemide, his hearing will improve.

2. Furosemide may cause ototoxicity. The nurse should tell the client to promptly report the hearing loss, dizziness, or tinnitus, to help prevent permanent ear damage. Hearing loss is not inevitable, and it is inappropriate to make assumptions about the cause of symptoms without a thorough evaluation. The client's system will not "adjust," and hearing loss will not resolve.

41. The best method to remove cerumen from a client's ear involves: 1. Inserting a cotton-tipped applicator into the external canal. 2. Irrigating the ear gently. 3. Using aural suction. 4. Using a cerumen curette.

2. Irrigation is the first strategy to loosen cerumen. Successful removal of the cerumen involves gentle irrigation behind the impacted cerumen. The flow of the water must be behind the impaction to remove the cerumen from the canal. A cotton-tipped applicator or other device is not appropriate because it can cause damage to the eardrum. Use of aural suction or a cerumen curette is appropriate only if the impacted cerumen cannot be removed by irrigation.

18. A client with glaucoma is to receive 3 gtt of acetazolamide (Diamox) in the left eye. What should the nurse do? 1. Ask the client to close his right eye while administering the drug in the left eye. 2. Have the client look up while the nurse administers the eyedrops. 3. Have the client lift his eyebrows while the nurse positions the hand with the dropper on the client's forehead. 4. Wipe the eyes with a tissue following admin- istration of the drops.

2. The client should look up while the nurse instills the eyedrops. The client will need to keep both eyes open while the nurse administers the drug. If the client raises his eyebrows while the nurse's hand is positioned on the eyebrows, the movement of the forehead may cause the dropper to move and injure the eye. The client should gently blink his eyes after the eyedrops have been instilled. Using a tissue to wipe the eyes could remove some of the medication; excess fluid can be removed with a cotton ball.

21. The expected outcome of using miotics to treat glaucoma is: 1. Paralyzing ciliary muscles. 2. Constricting intraocular vessels. 3. Constricting the pupil. 4. Relaxing ciliary muscles.

3. A miotic agent constricts the pupil and contracts ciliary musculature. These effects widen the filtration angle and permit increased outflow of aqueous humor. Miotics also cause vasodilation of the intraocular vessels, where intraocular fluids leave the eye, also increasing aqueous humor outflow. Mydriatics cause cycloplegia, or paralysis of the ciliary muscle.

60. The nurse is admitting a client with glaucoma. The client brings prescribed eye drops from home and insists on using them in the hospital. The nurse should: 1. Allow the client to keep the eye drops at the bedside and use as prescribed on the bottle. 2. Place the eye drops in the hospital medication drawer and administer as labeled on the bottle. 3. Explain to the client that the physician will write an order for the eye drops to be used at the hospital. 4. Ask the client's wife to assist the client in administering the eye drops while the client is in the hospital.

3. In order to prevent medication errors, clients may not use medications they bring from home; the physician will order the eye drops as required. It is not safe to place the eye drops in the client's medication box or to permit the client to use them at the bedside. The nurse should ask the wife to take the eye drops home.

58. To ensure safety for a hospitalized blind client, the nurse should: 1. Require that the client has a sitter for each shift. 2. Require that the client stays in bed until the nurse can assist. 3. Orient the client to the room environment. 4. Keep the side rails up when the client is alone.

3. The priority goal of care for a client who is blind is safety and preventing injury. The initial action is to orient the client to a new environment. Taking time to identify the objects and where they are located in the room can achieve this goal. It is unrealistic to have someone stay with the client at all times or for the client to stay in bed until the nurse can assist. Using side rails creates unnecessary barriers and may be a safety hazard.

7. A short time after cataract surgery, the client complains of nausea. The nurse should first: 1. Instruct the client to take a few deep breaths until the nausea subsides. 2. Explain that this is a common feeling that will pass quickly. 3. Tell the client to call the nurse promptly if vomiting occurs. 4. Medicate the client with an antiemetic, as ordered.

4. A prescribed antiemetic should be administered as soon as the client complains of nausea following a cataract extraction. Vomiting can increase intraocular pressure, which should be avoided after eye surgery because it can cause complications. Deep breathing is unlikely to relieve nausea. Postoperative nausea may be common; however, it doesn't necessarily pass quickly and can lead to vomiting. Telling the client to call only if vomiting occurs ignores the client's need for comfort and interven- tion to prevent complications.

25. Which of the following clinical manifestations should the nurse assess when a client has acute angle-closure glaucoma? 1. Gradual loss of central vision. 2. Acute light sensitivity. 3. Loss of color vision. 4. Sudden eye pain.

4. Acute angle-closure glaucoma produces abrupt changes in the angle of the iris. Clinical manifestations include severe eye pain, colored halos around lights, and rapid vision loss. Gradual loss of central vision is associated with macular degeneration. The loss of color vision, or achromatopsia, isa rare symptom that occurs when a stroke damages the fusiform gyrus. It most often affects only half of the visual field.

38. The client with a hearing aid does not seem to be able to hear the nurse. The nurse should do which of the following? 1. Contact the client's audiologist. 2. Cleanse the hearing aid ear mold in normal saline. 3. Irrigate the ear canal. 4. Check the hearing aid's placement.

4. Inadequate amplification can occur when a hearing aid is not placed properly. The certified audiologist is licensed to dispense hearing aids. The ear mold is the only part of the hearing aid that may be washed frequently; it should be washed daily with soap and water. Irrigation of the ear canal is done to remove impacted cerumen or a foreign body.

48. The risk for injury during an attack of Ménière's disease is high. The nurse should instruct the client to take which immediate action when experiencing vertigo? 1. "Place your head between your knees." 2. "Concentrate on rhythmic deep breathing." 3. "Close your eyes tightly." 4. "Assume a reclining or flat position."

4. The client needs to assume a safe and comfortable position during an attack, which may last several hours. The client's location when the attack occurs may dictate the most reasonable position. Ideally, the client should lie down immediately in a reclining or flat position to control the vertigo. The danger of a serious fall is real. Placing the head between the knees will not help prevent a fall andis not practical because the attack may last several hours. Concentrating on breathing may be a useful distraction, but it will not help prevent a fall. Closing the eyes does not help prevent a fall.

35. To approach a deaf client, the nurse should do which of the following first? 1. Knock on the room's door loudly. 2. Close and open the vertical blinds rapidly. 3. Talk while walking into the room. 4. Get the client's attention.

4. The nurse should avoid startling the client who is deaf and should obtain the attention of the client before speaking. The client who is deaf cannot hear knocking on the door or talking. Opening the blinds is not a helpful way to get the client's attention.

49. The nurse should assess the client with Ménière's disease for the intended outcomes of which of the following medications that are commonly used to manage the disease? Select all that apply. 1. Antihistamines. 2. Antiemetics. 3. Diuretics. 4. Non-steroidal anti-inflammatory drugs (NSAIDs). 5. Antipyretics.

1, 2, 3. Since the symptoms of Ménière's disease are associated with a change in the fluid volume of the inner ear, a wide variety of medications may be used in an attempt to control the signs/symptoms of Ménière's disease, including antihistamines, antiemetics, tranquilizers, and diuretics. NSAIDs and antipyretics play no significant role in Ménière's disease management.

47. Which of the following statements indicates the client understands the expected course of Ménière's disease? 1. "The disease process will gradually extend to the eyes." 2. "Control of the episodes is usually possible, but a cure is not yet available." 3. "Continued medication therapy will cure the disease." 4. "Bilateral deafness is an inevitable outcome of the disease."

2. There is no cure for Ménière's disease, but the wide range of medical and surgical treatments allows for adequate control in many clients. The disease often worsens, but it does not spread to the eyes. The hearing loss is usually unilateral.

22. Which of the following should the nurse provide as part of the information to prepare the client for tonometry? 1. Oral pain medication will be given before the procedure. 2. It is a painless procedure with no adverse effects. 3. Blurred or double vision may occur after the procedure. 4. Medication will be given to dilate the pupils before the procedure.

2. Tonometry, which measures intraocular pressure, is a simple, noninvasive, and painless procedure that requires no particular preparation or postprocedure care and carries no adverse effects. It is not necessary to dilate the pupils for tonometry.

28. A 75-year-old male client has a history of macular degeneration. While he is in the hospital, the priority nursing goal will be: 1. To provide education regarding community services for clients with adult macular degeneration (AMD). 2. To provide health care related to monitoring his eye condition. 3. To promote a safe, effective care environment. 4. To improve vision.

3. AMD generally affects central vision. Confusion may result related to the changes in the environment and the inability to see the environment clearly. Therefore, providing safety is the priority goal in the care of this client. Educating him regarding community resources or monitoring his AMD may have been done at an earlier date or can be done after assessing his knowledge base and experience with the disease process. Improving his vision may not be possible.

34. Which of the following statements would indicate to the nurse that the client who has under- gone repair of her nasal septum has understood the discharge instructions? 1. "I should not shower until my packing is removed." 2. "I will take stool softeners and modify my diet to prevent constipation." 3. "Coughing every 2 hours is important to pre- vent respiratory complications." 4. "It is important to blow my nose each day to remove the dried secretions."

2. Constipation can cause straining during defecation, which can induce bleeding. Showering is not contraindicated. The client should take mea- sures to prevent coughing. The client should avoid blowing her nose for 48 hours after the packingis removed. Thereafter, she should blow her nose gently using the open-mouth technique to minimize bleeding in the surgical area.

4. The client with a cataract tells the nurse that she is afraid of being awake during eye surgery. Which of the following responses by the nurse would be the most appropriate? 1. "Have you ever had any reactions to local anesthetics in the past?" 2. "What is it that disturbs you about the idea of being awake?" 3. "By using a local anesthetic, you won't have nausea and vomiting after the surgery." 4. "There's really nothing to fear about being awake. You'll be given a medication that will help you relax."

2. The nurse should give a client who seems fearful of surgery an opportunity to express her feelings. Only after identifying the client's concerns can the nurse intervene appropriately. Asking the client about previous reactions to local anesthetics maybe warranted, but it does not address the client's concerns in this instance. Telling the client that she will not have nausea or vomiting ignores the client's feelings of fear and does not provide any data about the client's feelings. More data would help the nurse plan care. Telling the client that there is nothingto be afraid of minimizes her feelings and does not address her concerns. Premature explanations and clichés do not provide needed assessment data and ignore the client's feelings.

19. A client who has been treated for chronic open-angle glaucoma (COAG) for 5 years asks the nurse, "How does glaucoma damage my eyesight?" The nurse's reply should be based on the knowledge that COAG: 1. Results from chronic eye inflammation. 2. Causes increased intraocular pressure. 3. Leads to detachment of the retina 4. Is caused by decreased blood flow to the retina.

2. In COAG, there is an obstruction to the outflow of aqueous humor, leading to increased intraocular pressure. The increased intraocu-lar pressure eventually causes destruction of the retina's nerve fibers. This nerve destruction causes painless vision loss. The exact cause of glaucoma is unknown. Glaucoma does not lead to retinal detachment.

24. The nurse observes the client instill eye- drops. The client says, "I just try to hit the middle of my eyeball so the drops don't run out of my eye." The nurse explains to the client that this method may cause: 1. Scleral staining. 2. Corneal injury. 3. Excessive lacrimation. 4. Systemic drug absorption.

2. The cornea is sensitive and can be injured by eyedrops falling onto it. Therefore, eyedrops should be instilled into the lower conjunctival sac of the eye to avoid the risk of corneal damage. The drops do not cause scleral staining or excessive lacrimation. Systemic absorption occurs when eyedrops enter the tear ducts.

26. A client has been diagnosed with an acute episode of angle-closure glaucoma. The nurse plans the client's nursing care with the understanding that acute angle-closure glaucoma: 1. Frequently resolves without treatment. 2. Is typically treated with sustained bed rest. 3. Is a medical emergency that can rapidly lead to blindness. 4. Is most commonly treated with steroid therapy.

3. Acute angle-closure glaucoma is a medical emergency that rapidly leads to blindness if left untreated. Treatment typically involves miotic drugs and surgery, usually iridectomy or laser therapy. Both procedures create a hole in the periphery of the iris, which allows the aqueous humor to flow into the anterior chamber. Bed rest does not affect the progression of acute angle-closure glaucoma. Steroids are not a treatment for acute angle-closure glaucoma; in fact, they are associated with the development of glaucoma.

2. A client is having a cataract removed and will use eyeglasses after the surgery. The nurse should develop a teaching plan that includes which of the following? Select all that apply. 1. Images will appear to be one-third larger. 2. Look through the center of the glasses. 3. The changes will be immediate. 4. Use handrails when climbing stairs. 5. Stay out of the sun for 2 weeks.

1, 2, 4. The use of glasses following cataract surgery does not totally restore binocular vision. Glasses will cause images to appear larger and peripheral vision will be distorted; the client should look through the center of the glasses and turn his or her head to view objects in the periphery. The client should also use caution when walking or climbing stairs until he or she has adjusted to the change in vision. Changes in vision following cataract surgery are not immediate and the nurse can instruct the client to be patient while adjusting to the changes. The client does not need to stay out of the sun, but should wear dark glasses to prevent discomfort from photophobia.